Healthcare Provider Details

I. General information

NPI: 1962522276
Provider Name (Legal Business Name): NANCY CAWTHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 HOLLANDALE LN STE 300
FARMERS BRANCH TX
75234-2035
US

IV. Provider business mailing address

3330 COUNTRY SQUARE DR # 601
CARROLLTON TX
75006-8720
US

V. Phone/Fax

Practice location:
  • Phone: 972-247-7500
  • Fax: 972-247-8811
Mailing address:
  • Phone: 469-854-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number95576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: